BlueCard^® connection: Why was my claim for a Medicaid-enrolled member rejected?

Claims for Medicaid-enrolled members must be billed according to Medicaid reporting requirements. When a member is enrolled in a Medicaid plan in another state — and the Medicaid plan is administered by a Blue plan — your claim will be routed to the plan where the member is enrolled. The member’s three-letter alpha-prefix identifies the plan and state where the patient is enrolled.

Plans may also require you to register as a Medicaid provider with their plans before approving reimbursement on the claim. To ensure you’re billing the claim accurately and have met the plan’s state Medicaid requirements, be sure to verify your patient’s eligibility and benefits. Failure to report the claim according to Medicaid requirements could result in a request from the plan for additional information or a claim denial.

For more information on the BlueCard program, including links and articles on online tools, reference the BlueCard chapter of the online provider manuals.

Have a question you’d like answered?
If you’re experiencing issues with the information provided in the BlueCard chapter of the online manual — or if you’d like more information on a particular topic — contact your provider consultant.

Want to suggest a topic to be covered in this series? Send an email to ProvComm@bcbsm.com and put “BlueCard series” in the subject line.